Today, more than 160 million Americans participate in an employer-sponsored health benefits plan. However, due to the rising cost of health care services, even those with employer-sponsored plans are regularly faced with unaffordable point-of-care expenses.
In addition to affordability, many workers face social barriers outside of the health plan that impact their ability to interact with the medical system in the most efficient and effective manner.
We refer to this issue as a broader view of social determinants of health (SDOH) impacting working Americans—daily factors within and outside a clinical setting that may affect a person’s health and interactions with the medical system. Elements of this view of SDOH include workplace environment and workers’ knowledge of how their health plan operates, as well as traditional SDOH items like access to healthy foods, ease of transportation, walkability and neighborhood safety, among others.
Traditionally, many SDOH-related interventions have focused on individuals who are Medicaid beneficiaries. However, most of the opportunity to address SDOH may actually be elsewhere. This is important for many plan sponsors, and it represents an urgent matter for organizations with many lower-wage workers who are all too often disproportionately impacted by chronic diseases.
In public health today, much of the discussion around SDOH is focused heavily on where a person lives. After all, we know that a person’s zip code is a better indicator of their life expectancy than other factors, including genetics.
With this said, we still have a significant opportunity to address SDOH by shifting the conversation to include the one place a person spends most of their waking hours—their place of work.
Looking at SDOH through the workplace lens
Employers have a significant incentive to address SDOH disparities among their workforce, particularly as it relates to lower-wage workers.
Data from the National Institutes of Health (NIH), other independent sources and Aetna’s own data shows these individuals tend to be less engaged in health support programs, maintain riskier lifestyles (e.g., higher rates of smoking and lower rates of seatbelt use), and sometimes access the health care system in less efficient ways (e.g., using the emergency room when it is not necessary).
According to the CDC, employees with chronic diseases and unhealthy behaviors create a ripple effect of significant costs for employers, including increased medical costs, absenteeism, high costs for replacement workers and high administrative expenses.
For people-driven businesses such as retail or hospitality, these costs extend beyond dollars—potentially adversely impacting quality control, safety and morale.
Despite the challenges, there are opportunities for any type of business to both address and change how health care is delivered. At Aetna, we are seeing this in action through a first-of-its-kind pilot engagement we have deployed with several leading large employers across a variety of industries.
Using the employer-employee relationship to effect change
Community health experts are quite adept at identifying communities where particular SDOH issues are impacting people on a large scale, such as targeting a food desert and establishing a farmer’s market or providing transportation support to improve access to health care services.
We can achieve the same goal among employee populations by analyzing data and identifying health disparities that not only impact a company’s bottom line, but more importantly, the health and productivity of their employee population.
As an employer, you may discover a pocket of your workforce is inefficiently using the health care system—perhaps overusing out-of-network care or visiting the emergency room as a source of frontline primary care rather than going to a doctor’s office for annual check-ups and preventive screenings.
Armed with that information, you can create tailored solutions that help your workforce better use the system—improving health outcomes while also saving valuable resources.
Through our Analyze Rethink Transform (ART) analytics tool, we take out the guesswork and address how an employer’s most vulnerable employees are currently receiving care, where the missed opportunities are, measuring the financial impact and determining how help can be offered.
This can be done for Aetna commercial plan sponsors, regardless of location or industry. Using new analytics, we’re creating a way for the nation’s employers—from those in retail to hospitality to financial services—to quickly identify and quantify the impact of their highest priority health disparities.
We’re using a proprietary algorithm to measure health against a series of key factors and indicators, including:
- Plan performance
- Medical cost savings opportunities
- Population characteristics
- Prevalence of avoidable and manageable conditions
- Adverse clinical outcomes
- Member engagement with care management programs
- Plan enrollment and preventative screening compliance
Working with a cross-functional team, employers can partner with their Aetna account teams to help better address serious gaps, anticipate priority issues and create sustainable solutions. The pilot studies we have underway are helping us build a library of ROI-based solutions to the health disparities most commonly seen in employer-sponsored health plans.
We’re confident in our ability to help employers improve health outcomes for their employee populations by using data and analytics to target tailored solutions. In the case of SDoH, what’s good for business is also a public good.
Using data and analytics to improve health outcomes isn’t just a prescription for a better bottom line, it’s a direct reflection of the impact businesses have on the lives of their employees and on the communities in which they operate.
Garth Graham, M.D., is vice president of community health and impact for CVS Health and president of the Aetna Foundation. Andrew Hiles is vice president of plan sponsor insights at Aetna.